PRENATAL MANAGEMENT

A. FIRST VISIT: as soon as the mother missed a menstrual period when pregnancy is suspected.
B. SCHEDULE OF VISITS:
 1st 32 weeks- once a month
 32 to 36 weeks- every 2 weeks
 36 to 42 weeks – every week
C. CONDUCT OF INITIAL VISIT
1. Baseline Data Collection
a. To serve as a basis for comparison with information gathered on subsequent visits.
b. To screen for high-risk factors
2. Obstetrical History
a. Menstrual History- menarche (onset, regularity, duration, frequency, character)
b. Last Menstrual Period (LMP), sexual history, methods of contraception
c. Past Menstrual Period (PMP), menstrual period before the last
3. Medical and Surgical History- past illnesses and surgical procedures, current drugs used
4. Family History to detect illnesses or conditions that are transmittable
5. Current Problems – activities of daily living, discomforts, danger signs
6. Initial and Subsequent Visits
a. Vital signs
 Temperature: slight rise because of increased progesterone & increased activity of the
thyroid gland; not to reach 38 °C.
 Pulse rate: plus 10 to 15 bpm
 Respiratory rate: May tend to be rapid and deep (16/min., deeper) because of
progesterone’s influence on the respiratory center. Maximum increase under normal
conditions: 24/min. at rest.
 BP: Tends to be hypotensive with supine position: vena caval syndrome.
 Prevention: Left Lateral Recumbent, BP lowest in the 2nd trimester. Elevated BP reading,
may indicate PIH.
 Roll-over test can be done in the first trimester for early detection of developing
PIH by 20-24 weeks.
b. Weight is checked in every visit.
 Total weight gain: 20-25 lb., with average of 24 lb. upper limit: 25 to 35 lb.
 1st trimester: 1 lb- 3 lbs,
 2nd trimester: 11 lbs.
 3rd trimester: 11 lbs.
 The pattern of weight gain is more important than the amount of weight gain.
 Normal weight gain patterns contribute to health of mother and fetus.
 Failure to gain weight is an ominous sign.
 Weight is therefore a measure of health of a pregnant mother.
c. Urine testing for albumin and sugar
 Sugar – ideally not more than 1+
 Albumin - negative
d. Fetal growth and development assessment
 Fundal height
 Fetal heart tones/ fetal heart rate
 Abdominal palpation – Leopold’s maneuver
 Quickening – first fetal movement, plus subsequent motility
7. Obstetrical History
a. Preceding pregnancies and perinatal outcomes:
 4-Point System: Past pregnancies and perinatal outcomes (FPAL)
F: number of full term births
P: number of premature births
A: number of abortions
L: number of currently living children
  5-Point System: The total number of pregnancies (G) is the first number (GFPAL)
G: total number of pregnancies
F: number of full term births
P: number of premature births
A: number of abortions
L: number of currently living children
b. Gravida: number of pregnancies regardless of duration and outcomes, including the present
pregnancy
 Gravida 1 (G)- pregnant for the first time; primigravida had one pregnancy
 Multigravida – with two or more pregnancies
 Nulligravida – woman who is pregnant now and has never been pregnant
c. Parity: number of pregnancies carried to period of viability whether born dead or alive at
birth (twins is considered as one parity)
 Primapara: a woman who has once delivered a fetus or fetuses who reached the stage of
viability. Therefore, completion of pregnancy beyond the period of abortion means one
parity, it also means that any abortion is not included in the counting.
 Multipara: a woman who has completed two or more pregnancies to the stage of
viability.
8. Estimates in Pregnancy
a. EDC/EDD:
b. Age of Gestation:
c. EFW:
d. EFL:
9. Complete Physical Examination
a. Internal Examination
b. Important concerns of Physical Examination
c. Laboratory Tests